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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Meningococcal septic shock is an important cause of morbidity and mortality in children and young adults worldwide and is the prototypical gram-negative septic shock. One of the key factors in the development of shock is increased microvascular permeability. Vascular endothelial growth factor (VEGF) is a central factor in angiogenesis and is an important mediator of vascular permeability. Thirteen patients with meningococcal infection (eight presenting with shock) were investigated in the early phase of invasive meningococcal disease. Cytokines, complement activation, and VEGF plasma concentrations were measured during the first 48 h on the pediatric intensive care unit. Increased cytokine concentrations and activation of the complement system were observed. VEGF plasma concentrations were increased (median 193 pg/mL, range 71-1082) and were highest in the presence of shock (208 pg/mL, 169-1082) compared with patients presenting without shock (92 pg/mL range 71-299). VEGF concentration at admission correlated with the severity of disease (pediatric risk of mortality score, R=0.90 [Spearman], P=0.0001) and the amount of fluids administered within the first 24 h (R=0.90, P<0.0001). In all patients, a decrease in VEGF was associated with a decrease in fluid intake during t=24 to 48 h. The results suggest that apart from correlation with IL-1 beta, -10, -12, and complement activation, microvascular permeability in sepsis is also closely linked to the plasma concentration of VEGF. The role of VEGF in sepsis-associated increased microvascular permeability needs further exploration and may represent a new therapeutic target.
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PMID:Vascular endothelial growth factor is increased during the first 48 hours of human septic shock and correlates with vascular permeability. 1631 77

Microbiological tests for diagnosis of acute meningococcal disease are important for the clinical management of patients with this often-fatal illness, but cultures are frequently negative after antibiotics have been administered. Retrospective studies suggest that examination of skin biopsies may aid a rapid diagnosis and that cultures of skin biopsies are often positive even after antimicrobial treatment has commenced. This prospective controlled study aimed to assess the diagnostic value of skin biopsy compared with investigations of blood and cerebrospinal fluid (CSF) in patients with skin lesions and presumed meningococcal disease. A total of 43 patients, 31 with suspected acute meningococcal infection and 12 controls, were included. All skin biopsies were investigated by Gram stain and routine microbiological culture. In 25 patients, meningococcal infection was diagnosed microbiologically. The clinical diagnosis was meningococcal meningitis in 8 patients, meningococcal sepsis in 11 patients, and a combination of both in 6 patients. The sensitivity of cultures of blood, CSF, and skin biopsies was 56%, 50%, and 36%, respectively. When culture and Gram stain were combined, positive results were obtained in 56%, 64%, and 56%, respectively. There was no correlation between the diagnostic yield of skin biopsies and previous antibiotic treatment. In 14 patients, the diagnosis was based exclusively on one positive sample: CSF in 7 (28%) patients, blood in 4 (16%) patients, and skin biopsy in 3 (12%) patients. The sensitivity of skin biopsies was highest in patients with the least extensive skin lesions. Specificity was 100%. Microbiological investigation of skin biopsies increased the diagnostic yield and could be considered a component of the routine diagnostic work-up in patients with suspected meningococcal infection, even after the initiation of antimicrobial treatment.
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PMID:Prospective controlled study of the diagnostic value of skin biopsy in patients with presumed meningococcal disease. 1696 10

Meningococcal disease may present as sepsis, meningitis or a combination of both. Protein C (PC) is an important regulator of thrombin activity. Two polymorphisms in the promoter region of PC (C-1654T, A-1641G) have been shown to affect PC levels. In patients with meningococcal sepsis, low PC levels have been correlated with increased severity and poor outcome. We established a multicenter case-control study to determine whether PC promoter polymorphisms are associated with occurrence and outcome of meningococcal disease and sepsis. 288 previously healthy children with meningococcal infection from 97 pediatric hospitals in Germany, Switzerland, Italy, and Austria and 309 healthy controls were included in the study. A strong age-dependant effect was found. Patients younger than 1 year carried significantly more often the CG-CG genotype than healthy controls (28.6% vs. 17.8%, P = 0.04). Carriers of the CG allele showed a 3.43-fold increased odds ratio (OR) to develop sepsis (95% CI: 1.05-11.20; 85.7% vs. 63.6%, P = 0.036). The TA-TA genotype conferred a protective role for the development of sepsis (P = 0.017) with a Haldane OR of 0.09 (95% CI: 0.01-0.94). Systolic blood pressure values were significantly decreased in patients carrying the CG-CG genotype (70 vs. 86 mmHg, P = 0.005), and the need for adrenergic support significantly higher (70% vs. 26%, P = 0.018), resulting in an OR of 6.61 (95% CI: 1.28-34.14). These findings show that in young children PC promoter genotype is associated with susceptibility for meningococcal disease, the development of meningococcal sepsis, lower blood pressure, and need for adrenergic support.
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PMID:Protein C promoter polymorphisms associate with sepsis in children with systemic meningococcemia. 1756 89

Infection with Neisseria meningitidis usually results in life-threatening septicemia and/or meningitis. Occasionally, howerver, infection may be mild or localized. Awareness of this fact is essential to avoid delays in diagnosis, management and prophylaxis. Three cases are presented with localized or mild presentation. A 40-day-old male with purulent conjunctivitis, a six-year-old male with peritonitis and a nine-year-old with C5 deficiency with Neisseria meningitidis bacteremia who presented with a one day history of fever, but was not toxic, and was treated with oral antibiotics. However, he returned with a clinical picture of systemic infection. Based on these three cases, we suggest an aggressive diagnostic, therapeutic and prophylactic approach whenever meningococcal infection is strongly suspected.
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PMID:Unusual presentation of meningococcal infection. 1759 Jul 25

In patients with meningococcal infection, devastating presentations, such as purpura fulminans, which can progress to extensive tissue necrosis of the limbs and digits, have a significant social impact. The case presented herein illustrates such a phenomenon in a patient who developed bilateral necrosis of the lower extremities as a result of infection with Neisseria meningitis. We emphasize that severe myalgia was the first clinical manifestation of meningococcal purpura fulminans in our case. However, myalgia has typically been overlooked and undervalued as an early clinical feature of meningococcal sepsis. Early recognition and prompt initial antibiotic therapy continue to be the cornerstones of the successful management of this dramatic disease, reducing morbidity and mortality.
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PMID:Severe myalgia of the lower extremities as the first clinical feature of meningococcal purpura fulminans. 1797 78

Neisseria meningitidis is a global cause of meningitis and septicemia. Immunity to N. meningitidis involves both innate and specific mechanisms with killing by serum bactericidal activity and phagocytic cells. C-reactive protein (CRP) is an acute-phase serum protein that has been shown to help protect the host from several bacterial pathogens, which it recognizes by binding to phosphorylcholine (PC) on their surfaces. Pathogenic Neisseria species can exhibit phase-variable PC modification on type 1 and 2 pili. We have shown that CRP can bind to piliated meningococci in a classical calcium-dependent manner. The binding of CRP to the meningococcus was concentration dependent, of low affinity, and specific for PC. CRP appears to act as an opsonin for N. meningitidis, as CRP-opsonized bacteria showed increased uptake by human macrophages and neutrophils. Further investigation into the downstream effects of CRP-bound N. meningitidis may lead us to a better understanding of meningococcal infection and help direct more effective therapeutic interventions.
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PMID:The acute-phase reactant C-reactive protein binds to phosphorylcholine-expressing Neisseria meningitidis and increases uptake by human phagocytes. 1819 32

Scientific knowledge of meningococcal infection has increased greatly since the epidemic nature of the illness was first described by Vieusseux at the dawn of the nineteenth century. In fact, revolutionary advances have been made in public-health measures, antimicrobial therapy, diagnostic procedures, anti-inflammatory drugs and supportive care facilities. Based on the knowledge accumulated to date, it is generally accepted that the pathogenesis of meningococcal infection involves multiple links that interconnect in a complex web of phenomena from Neisseria meningitidis attachment to meningococcal sepsis or meningitis. In fact, a myriad of strongly interacting inflammatory molecules and cells have been implicated in neisserial infection, illustrating the complexity of meningococcal pathogenesis. In addition, many of these signallers are critically involved in outcomes in the human host. Deciphering the pathogenesis of meningococcal infection could expand our knowledge and provide important clues to the host-pathogen interaction, as well as leading to the development of new therapeutic tools. Herein, we review the history of the discovery and characterization of meningococcal disease, epidemiological features of the disease with an emphasis on recent developments in Brazil, the cellular and molecular basis of disease, and discuss diagnosis and therapy.
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PMID:Two centuries of meningococcal infection: from Vieusseux to the cellular and molecular basis of disease. 1892 6

Neisseria meningitidis serogroup A septicemia and the development of Kawasaki disease in a 10-month-old male infant are described. The patient also experienced a number of primary/septic manifestations as consequences of the direct infectious assault and secondary/hypersensitivity immune-mediated complications. The present observation indicates an etiological relationship between invasive meningococcal infection group A and Kawasaki disease, an association in favor of superantigen-induced theory for the latter occurrence.
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PMID:Meningococcal group A sepsis associated with rare manifestations and complicated by Kawasaki-like disease. 1928 80

Neisseria meningitidis is a leading cause of bacterial meningitis and septicemia in the United States. Vaccines directed against meningococcal disease must elicit high and persistent titers of bactericidal antibodies against prevalent meningococcal serogroups and be highly efficacious in preventing meningococcal infection. Currently, 2 quadrivalent (A, C, W-135, Y) vaccines-a polysaccharide meningococcal vaccine and a conjugate meningococcal vaccine-are licensed in the United States. Neither is approved for use in infants or toddlers younger than 2 years of age. Results of studies with an investigational quadrivalent (ACWY) meningococcal CRM(197) glycoconjugate vaccine in infants demonstrate that this vaccine has potential to protect this age group. The availability of an effective vaccine for routine universal infant immunization is particularly important because the incidence of invasive meningococcal disease is greatest in infants for all serogroups and because achievable vaccination rates are much greater for infants and young children than they are for adolescents.
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PMID:Optimizing protection against meningococcal disease. 2008 51

Neisseria meningitidis, the meningococcus, is normally a harmless commensal bacterium that colonises the naso/oropharynx of humans. This antigenically variable gram-negative diplococcus has the potential, however, to cause rapidly progressing meningitis and fulminant septicemia, either separately or together (1,2). Once present in the bloodstream, meningococci grow rapidly and their highly toxic lipo-oligosaccharides frequently cause extensive tissue damage and severe toxic shock. The progress of the disease is swift, and death often occurs within hours of the onset of symptoms (3). Even in countries where meningococcal infection is relatively rare, it remains a high priority for public health services because of the high mortality rates of fulminant septicemic disease (which can be up to 40% even when intensive supportive therapy is available), the high proportion of sequelae in patients who have recovered (including brain damage and digit or limb loss), and the age groups most susceptible (young children and, to a lesser extent, teenagers) (4,5).
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PMID:The Impact o Molecular Techniques on the Study of Meningococcal Disease. 2139 Jul 52


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